Plasma immunoglobulin E and risk of exacerbation and mortality in chronic obstructive pulmonary disease: A contemporary population- based cohort

Background: Novel biomarkers and targeted treatments are needed for patients with chronic obstructive pul-monary disease (COPD). Objective: To test the hypothesis that high plasma immunoglobulin (Ig)E concentrations associate with increased risk of exacerbation and mortality in individuals with COPD in the general population. Methods: Among 46,598 adults in the Copenhagen General Population Study, we included 1559 with COPD, defined as forced expiratory volume in 1 second/forced vital capacity < 0.70 and forced expiratory volume in 1 second < 80% predicted in individuals aged >= 40 years with chronic respiratory symptoms and smoking exposure >= 10 pack-years, and without asthma. We assessed risk of future severe exacerbation and all-cause mortality according to baseline plasma IgE >= 76 IU/mL, a clinical cutoff for omalizumab treatment in severe asthma.Results: During 14 years of follow-up (median, 6.9; interquartile range, 3.4), we recorded 224 severe exacerba-tions and 434 deaths in 1559 individuals with COPD. Individuals with COPD with IgE >= 76 IU/mL vs those with < 76 IU/mL had a multivariable adjusted hazard ratio (HR) of 1.43 (95% confidence interval, 1.07-1.89) for severe exacerbation and 1.30 (1.05-1.62) for all-cause mortality. Compared with individuals with IgE < 76 IU/mL and blood eosinophils < 300 cells/mL, the multivariable adjusted HR for severe exacerbation was 1.12 (0.76-1.67) for those with IgE < 76 IU/mL and blood eosinophils >= 300 cells/mL, 1.62 (1.17-2.24) for IgE >= 76 IU/mL and blood eosinophils < 300 cells/mL, and 1.06 (0.63-1.77) for those with IgE >= 76 IU/mL and blood eosinophils >= 300 cells/ mL. Corresponding HRs for all-cause mortality were 1.27 (0.99-1.63), 1.47 (1.14-1.88), and 1.17 (0.83-1.64), respectively.Conclusion: High plasma IgE was associated with an increased risk of severe exacerbation and all-cause mortal-ity in individuals with COPD in the general population, independent of blood eosinophils. (c) 2022 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. This is an open access arti-cle under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Automated summary

High plasma IgE is associated with an increased risk of severe exacerbation and all-cause mortality in individuals with COPD in the general population.